Oscar E. Suman

Quality of life of young adult survivors of pediatric burns using World Health Organization Disability Assessment Scale II and Burn Specific Health Scale-Brief: a comparison

The objective was to determine long-term psychological distress and quality of life (QOL) in young adult survivors of pediatric burns using the World Health Organization Disability Assessment Scale II (WHODAS) and the Burn Specific Health Scale-Brief (BSHS-B). Fifty burn survivors 2.5 to 12.5 years postburn (16–21.5 years old; 56% male, 82% Hispanic) completed the WHODAS and BSHS-B. The WHODAS measures health and disability and the BSHS-B measures psychosocial and physical difficulties. Scores were calculated for each instrument, and then grouped by years postburn, TBSA, sex, burn age, and survey age to compare the effects of each. Next, the instruments were compared with each other. The WHODAS disability score mean was 14.4u2009±u20092.1. BSHS-B domain scores ranged from 3 to 3.7. In general, as TBSA burned increased, QOL decreased. Female burn survivors, survivors burned prior to school entry, and adolescents who had yet to transition into adulthood reported better QOL than their counterparts. In all domains except Participation, the WHODAS consistently identified more individuals with lower QOL than the BSHS-B. Young adult burn survivors’ QOL features more disability than their nonburned counterparts, but score in the upper 25% for QOL on the BSHS-B. This analysis revealed the need for long-term psychosocial intervention for survivors with larger TBSA, males, those burned after school entry, and those transitioning into adulthood. Both instruments are useful tools for assessing burn survivors’ QOL and both should be given as they discern different individuals. However, the WHODAS is more sensitive than the BSHS-B in identifying QOL issues.

Follow-up Range of Motion in a Music and Movement-Based Exercise with Rehabilitation Program versus Standard of Care in Very Young Children with Severe Burns: 140.

Introduction: Standard care for the prevention and treatment of abnormal scarring after burn injury includes pressure garment therapy (PGT); however, clinical trials underlying this recommendation have been small, underpowered, and of poor methodological quality. Objectives: To determine the efficacy of PGT compared to control for the prevention and treatment of abnormal scarring after burn injury. Methods: Randomized control trials (RCTs) were identified from CINHAL, EMBASE, MEDLINE, CENTRAL, the “grey literature” and hand searching of the Proceeding of the American Burn Association. Primary authors and pressure garment manufacturers were contacted to identify eligible trials. Bibliographies from included studies and reviews were searched. Included studies were limited to RCTs of patients with burn wounds, treated with PGT or no pressure garment therapy. Two reviewers independently selected articles for inclusion and assessed methodological quality. Two reviewers independently extracted data; the primary outcomes was Vancouver Scar Scale. Missing data were obtained from authors or calculated from other data presented in the paper. The data were analyzed using the Cochrane Review Manager 4.2.3. Studies were pooled to yield weighted mean differences (WMD), standardized mean difference (SMD) or odds ratios (OR) and reported using 95% confidence intervals (95% CI). Results: From 131 references, 10 RCTs met inclusion criteria. No differences were identified in the mean change in global VSS score at 6 months in PGT and non PGT treated scars (WMD: 0.46; 95% CI: 1.07 to 0.16). Results of the secondary outcome measures also showed no significant treatment effect. Conclusions: The beneficial effects of PGT on scar appearance remain unproven, and the cost of PGT and potential adverse effects are not insignificant. Given current evidence, additional research is required to examine the effectiveness, risks and costs of PGT.

Teamwork for total burn care

Abstract The survivor rate of patients with severe burns has increased in the past decades. Some burn centers have teams composed of experts, clinicians, and personnel all knowledgeable in their own specialized fields. The idea of a comprehensive burn care team is important because burn patient care requires the interaction of various specialists in different fields of medicine and rehabilitation. All members of the team need to interact in a synergistic manner in order to provide the best burn care and outcome for the patient. This chapter focuses on burn team composition, communication, approach to care, team building, and the role that every component of this multidisciplinary group has in relation to the patient and how all members of the team contribute to the best patient burn care.

Burn Rehabilitation Along the Continuum of Care

Abstract This chapter provides a comprehensive overview of how burn rehabilitation should be conducted along the continuum of care. The authors emphasize the importance of early rehabilitative interventions such as positioning, splinting, exercise, and functional mobility in the intensive care unit. They proceed to discuss and illustrate the various modalities practiced in burn rehabilitation, focusing on producing the best functional and cosmetic outcomes at the completion of the rehabilitative process.

Muscle Strength and Lean Mass After Long-Term Growth Hormone Treatment in Pediatric Burn Patients: 60.

Introduction: Severe trauma is associated with hypermetabolism and whole body catabolism. Recombinant human growth hormone (rhGH) has been shown to attenuate hypermetabolism during the acute phase after burn. The aim of this study was to determine the effect of rhGH on muscle strength and lean mass of severely burned children over a period of 24 months in those receiving rhGH treatment for the first 12 months post burn. Methods: Forty-four pediatric patients with over 40% total body surface area (TBSA) burns were studied for 24 months after burn. Patients were randomized to receive either rhGH (0.05 mg/kg body weight) or placebo for one year. Muscle strength and lean mass (LBM), measured by Dual-X-ray absorptiometry were determined for two years after burn. Results: Muscle strength and LBM were significantly improved during rhGH treatment compared to placebo (p 0.05). No adverse side effects from this treatment were observed. Conclusions: Administration of recombinant human growth hormone for one year after burn in children was safe and improves muscle strength and lean mass, thus improving the long term rehabilitation of these children.